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UF Health University of Florida
Student Health Care Center UNIVERSITY of FLORIDA
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Online Insurance Verification Form

PAYMENT FOR SERVICES AT THE STUDENT HEALTH CARE CENTER
Current Patients: Follow instructions below to submit insurance information to the Student Health Care Center ONLY. 

  1. Complete the electronic Online Insurance Verification Form below. Unless otherwise noted, all sections are required.  Patient Financial Services will contact you if there is an issue with any information provided.
  2. Upload a copy of the front AND back of the insurance card where indicated.
    • If you prefer, you may fax (352-392-7620) or email (verify@shcc.ufl.edu) this information to the SHCC.
  3. Contact the insurance company in advance of care to learn about policy benefits in detail, how your coverage will work in the Gainesville area and more.
  4. Bring your original insurance card to all appointments at the SHCC.

FREQUENTLY ASKED QUESTIONS: Click here.

 

Online Insurance Verification Form

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Accepted file types: jpg, gif, png, pdf, tiff, Max. file size: 125 MB.
File types accepted: JPG GIF, PNG, PDF, TIFF. An image of the front AND back of the insurance card may also be faxed (352-392-7620) or emailed (verify@shcc.ufl.edu) to the SHCC.
Patient/Student Financial Responsibility Agreement*

Patient/Student Information

Name*
Address - Local*
Birth Date*
Sex

Marital Status*
Ethnicity*
Race*

PRIMARY Insurance Information - REQUIRED

PRIMARY Insurance Claim Address
Who is the PRIMARY Policy Holder?*
Policy Holder Name*
Policy Holder Address*
Policy Holder Birth Date*
Sex of Policy Holder

OPTIONAL - SECONDARY Insurance Information

PLEASE NOTE: If including a secondary insurance policy, it is the policy holder’s responsibility to contact both insurance companies listed to verify which will act as primary and which will act as secondary
SECONDARY Insurance Claim Address
Who is the SECONDARY Policy Holder?
Policy Holder Name
Policy Holder Address
Policy Holder Birth Date
Sex of Policy Holder